Stand inside the box and think outside the box

The title of this editorial could be not easy to catch up with its meaning at the first sight. “Stand inside the box” and “think outside the box” sound like contradicted and opposite to each other, but they are in perfect harmony like Ebony-and-Ivory or Yin-and-Yang to each other.

One of the top discussed issues among world scientists recently is, using Scopus publication impact scores, the Stanford University has just released an update of the 2021 world list that represents the top 2% most influential (career impact) scientists from 1960 to 2020, and the 2020 most-cited scientists in various disciplines in the world (This report was prepared by a team of experts led by Prof. John Ioannidis, the eminent Professor at the Stanford University). To be enlisted among the top 2% most influential (career impact) scientists have been one of the ultimate goals for most the scientists in the world, of course, including orthodontists.

Surprisingly, I am among the list of “top 2% most influential (career impact) scientists.” I asked myself what I have done before and why an orthodontist like me could be named among the world’s top 2% most influential (career impact) scientists. I checked the publications of mine and found most of them were thoughts outside the box, such as the rapid canine retraction or interdental distraction osteogenesis was the first in the world that applied concept of distraction osteogenesis to accelerate tooth movement and to grow dentoalveolar process. I also was the first in the world who had the thought of using platelet-rich plasma for accelerating tooth movement without surgical insults to the alveolar bone. The invention of Yin-Yang archwire for the improvement of occlusal cant also is another example of thoughts outside the box.

In January–March 2021 issue of the APOS Trends in Orthodontics, I wrote an editorial entitled “Thoughts outside the box: Unsolved issues in Class III growth patients” to advocate thoughts outside the box by giving examples on how we could treat Class III growing by redirecting mandibular growth instead of by control mandibular growth amount in which we have been putting great efforts on for years but with no progress. To redirect mandibular growth was first proposed in a pilot study published in the APOS Trends in Orthodontics, and further a thorough clinical study will be published in 2022 (AJODO). The title of this previous editorial actually has illustrated the relation between thoughts outside the box and the unsolved issues: New thoughts outside the box are to solve the questions inside the box.

In addition, any thoughts or ideas outside the box should also stay in line with the needs of patients and within the scope of their profession. Any thoughts or ideas outside the box without considering the needs of patients or out of their profession could be just outliers or shots in the dark and could hardly be cited or referenced.

Thoughts outside the box without standing points inside the box would be vanished eventually!